Background

- The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living

One of the main features of the world population in the late 20th and early 21st centuries
has been the considerable increase in absolute and relative numbers of
the elderly in both developed and developing countries. According to
the World Health Organization, the number of elderly worldwide in 2004
was approximately 580 million and this figure is expected to increase
in the coming years [1].
The percentage of people over the age of 65 in Turkey in 1990 was 4.3%,
and this figure rose to 5.8% in 2003 and is estimated to represent 9.8%
of the total population by 2025 [2,3].
Turkey tends to be a traditional culture with a collectivist
orientation. The social structure is based on close-knit family
relationships. Children and other relatives are expected to provide for
the needs of older adults [4]. Therefore, only a small minority (approximately 4%) of the elderly population prefer institutional care [5].
However, the demand for institutional care has been increasing owing to
the economic and medical problems of the older population, changing
family lifestyles and the scarcity of available institutional services.
It is notable that those who prefer institutional care are usually
widowed, divorced or never married, have no children or close
relatives, and are in the low-income bracket [3,6,7]. Nearly three out of every five elderly people living in institutions have low income status [5].

As an overview, the total bed capacity of institutions in the
country that accept people aged 60 or over is approximately eighteen
thousand, and such institutions can currently be classified into two
groups: the first can be termed 'Elderly Care and Rehabilitation
Centers', established for older people functionally dependent in
respect of Activities of Daily Living (ADL) (bathing, dressing,
continence, feeding, ambulation, etc); the second can be termed
'Nursing Homes', established for the elderly who are functionally
independent or partially independent but need some assistance and
supervision in ADL. Psycho-social services, basic health services,
leisure time activities etc. are provided to the residents who are
admitted to the institutions by nurses, social workers, psychologists
and handicraft and sports instructors [5,8].

It is obvious that the social and medical problems of the elderly,
whose population is increasing rapidly in Turkey, will become an
important issue in the near future. In addition to longevity itself,
quality of life is also important; this entails fulfillment of personal
values and enjoyment of leisure time, and is influenced by physical,
psychological, mental, social and economic circumstances [9,10]. As Ebersole [11]
noted, the quality of life that leads to life satisfaction has become a
reliable tool for investigating the efficiency of health care services
and the effectiveness of rehabilitation programs.

The term 'quality of life' refers to an evaluation of the life
conditions of a person, group or population. Objective or normative
criteria can be used to measure quality of life, and these usually
involve the quality of the physical and social environment, physical
and mental health, and available support systems. However, subjective
criteria, such as how the person considers his/her life, can also be
used [12]. Subjective quality of life can be defined in terms of life satisfaction (LS), subjective well-being and happiness, etc. [12-14].
Life satisfaction, which includes factors such as health, education,
interpersonal relationships and socio-economic status, is believed to
be an evaluation of life in general [14].

Various studies have shown that limited ability to perform ADL also
means decreased life satisfaction. For instance, among the elderly
population in Sweden, those with reduced ADL capacity report several
diseases and functional impairments that can cause low
life-satisfaction [14]. Sato et al. [15] observed greater life satisfaction in Japanese pensioners living at home who had high levels of ADL.

There is a significant relationship between physical activity, functional status and health status in the elderly [16-18]. Decreases in these features are closely related to falls, which are a major problem area [19-23]. In addition, those who have had falls face the fear of falling again and tend to restrict their daily activities [22,24]. However, Laughton et al. [25]
have reported that balance performance is not always a risk factor for
elderly fallers; other factors should be considered, such as the risk
levels in activities undertaken.

It has been reported that inactivity is also associated with greater
behavioral risks and unhealthy lifestyles such as poor diet and smoking
[26-28]. Tatum and colleagues [29]
suggested detailed investigations into such health risks – unhealthy
diet, excessive alcohol and tobacco consumption, lack of regular
physical exercise, etc. – for promoting health in the elderly and for a
significant change in their lifestyle in the nursing home. Health
promotion in older people is a relatively new concept in geriatric
care, and its importance has increased because of studies reporting
that health-related behaviors could decrease the risk of secondary
disabilities [30,31].

As far as we know, there are no data in the literature regarding
life satisfaction status and health related behaviors, or the
association between these two, in elderly residents of nursing homes in
Turkey. There seems to be a need for additional investigation of the
links between the health-related risks and life satisfaction among
these residents. Thus, the aim of this cross-sectional study was to
investigate the association between life satisfaction and health
activities amongst functionally independent residents of nursing homes.